Effectiveness of Massage Therapy in Improving Range of Motion and Posture of Shoulder and Cervical Region in a Morbidly Obese Patient: A Case Report

Kianoosh Esraghian
Grant MacEwan University – Edmonton, Alberta, Canada


Background: Range of motion (ROM) is defined as the extent of movement of a joint for a
certain inter-segmental rotational movement. Range of motion is primarily restricted by
musculature and skeletal structures. It may also be affected by other factors such as age, gender,
and obesity, which can have debilitating effects. Lack of physical activity, reduction in function,
and fatty tissue surrounding the joints or adjacent structures may contribute to restrictions in
range of motion in obese individuals. Lack of suitable equipment and protocols for treating
morbidly obese individuals limits the effectiveness of the therapist and the desire of the patient to
consider massage therapy as a viable treatment option.

Objective: To demonstrate the effectiveness of massage therapy on reduction of symptoms in a
morbidly obese patient experiencing pain in the shoulder, restrictions in ROM during specific
movements, and acquired postural alterations.

Methods: A 58-year-old disabled, morbidly obese male presented with pain and stiffness in his
right shoulder. A student massage therapist conducted initial and final assessments and treated
the patient over a six-week period. Techniques were chosen to help the patient reach his goals of
reducing pain, and improving range of motion and posture. Techniques utilized were trigger
point therapy (TrP), soft tissue frictions (STF) and direct fascial (DF) techniques. Stretches were
chosen to help maintain results and promote active recovery.
Results: After five treatments, shoulder and cervical ROM increased and shoulder pain
diminished. The patient was able to move through the entirety of range with minimal discomfort.

Conclusion: Results suggest that with modified positioning and techniques, massage therapy
combined with therapeutic exercises can help reduce non-specific shoulder pain, increase range
of motion, and improve posture in morbidly obese patients.

Keywords: range of motion, obesity, homecare, shoulder, cervical


Massage Therapy as a Treatment for Rheumatoid Arthritis Affecting the Wrist and Hand: A Case Report

Brandy Sharpe
MacEwan University – Edmonton, Alberta, Canada


Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease with a characteristic
destructive nature, and is marked with periods of exacerbations and remissions. Affecting any
joint in the body, RA presents with inflammation, pain, stiffness, edema, and a decrease in joint
function over time. The cause of RA is unknown.

Objective: To examine the effects of massage therapy on RA affecting the wrist and hand using
goniometry, grip strength measures, pinch strength measures, and subjective pain scales.
Methods: The study period included an initial and final assessment with the treatment being six
massage therapy sessions carried out by a student massage therapist over a seven-week timespan.
The subject, a 64-year-old female, presented with RA affecting the left wrist and hand. The
intent of the treatment was to increase grip strength, pinch strength, and range of motion (ROM),
and to decrease pain. In order to achieve these goals, a massage routine with specific techniques
was created. Longitudinal stroking (effleurage), petrissage, trigger point (TrP) therapy, frictions,
manual oscillations, and paraffin wax were the methods applied to the affected hand and wrist.

Results: Grip and pinch strength improved in both the affected and unaffected hands. ROM
increased in the affected hand. The unaffected hand’s ROM results varied, with a slight increase
in one motion and a decrease in another. The subject reported a decrease in pain in the affected
wrist and hand.

Conclusion: The results suggest that certain massage therapy techniques, when implemented
regularly, have a positive effect on RA in the form of increasing strength and ROM, and
decreasing pain.

Keywords: Rheumatoid arthritis, massage, manual oscillations



The Use of Massage to Increase the Performance of a Brazilian Jiu-Jitsu Athlete by Increasing Range

Alta Schwab
Center for Neurosomatic Studies – Clearwater, Florida


Background: Brazilian Jiu-Jitsu is a modern combat martial art that utilizes joint locks to force an
opponent into submission. It is a high intensity combat sport that places unique stresses on the
body leading to atypical injuries and muscular imbalance, a possible predictor of injury. Athletes
with a history of low back pain have significant reductions in hip range of motion, and
maximum hip flexibility is necessary to perform optimally.

Participant: 40-year-old Caucasian male Jiu-Jitsu black belt presenting with restricted range of
motion in the right shoulder and both hips as well as left SI joint and posterior gluteal pain
Diagnosis: Herniated L4-5 disc with no other notable health issues
Purpose: To discover if the utilization of massage can increase the performance of a BJJ athlete
by increasing range of motion and decreasing pain.

Intervention: The practitioner a 25 year old female within 3 months of the end of her third
semester of a three-semester, 18-month program at the Center for Neurosomatic Studies
(CNS). Biweekly targeted, deep-tissue massage treatments were performed for five weeks. The
results were tracked using the Bournemouth MSK scale, PGIC, WOSI, active range of motion
measurements measured with a goniometer, and routine Posturology assessments.

Results: There was significant improvement in range of motion in the shoulder, elbow, and both
hips as well as eliminated SI joint pain and some diminished pain in the posterior gluteal area.
The patient also claimed to have experienced improved performance in BJJ training.
Discussion: The participant was training for a tournament throughout the duration of the study,
thus he was training more than normal (5-6 time weekly); this is likely why there was less
improvement in pain than there was improvement in functionality.

Keywords: Brazilian Jiu-Jitsu, range of motion, shoulder, hips, elbow.


Effects of Massage Therapy on Pain Associated with Partial Lumbarization of S1

Honorable Mention
Briana Covey
Canadian College of Massage and Hydrotherapy
Halifax, Nova Scotia, Canada

Introduction: Lumbarization, known as a transitional vertebra or lumbrosacral transitional
vertebra, is a congenital abnormality where the first segment of sacrum is not fused. The purpose
of this study is to explore the effects of massage therapy on the management of chronic low back
pain associated with right sided partial lumbarization of S1, by using General Swedish and non-
Swedish massage techniques.
Methods: The patient was chosen based on her chronic back pain due to her right sided partial
lumbarization of S1. A treatment plan was designed using General Swedish and non-Swedish
technique and performed for ten, one hour treatments. The patient’s progress was monitored
using a visual analogue scale for pain, energy, and quality of sleep, as well as assessment of
range of motion.
Results: Results showed a three point decrease in day-to-day pain of the patient. Improved
quality of sleep by two points and increased energy levels by three points in the morning and one
point in the evening were reported as well.
Conclusion: The outcomes of this study therefore suggests that massage therapy is an effective
treatment for managing chronic low back pain due to right sided partial lumbarization of S1.


A Specific MFR Technique for Treatment of Non-Specific Upper Quadrant Mylagia and Paraesthesia – A Case Study

Honorable Mention
Sebastien Vachon-Gravel
Atlantic College of Therapeutic Massage
Fredericton, New Brunswick, Canada

Objective: Investigate whether a case presenting with non-specific upper quadrant
muscle pain and neurological dysfunction would benefit from an isolated myofascial
release (MFR) technique, entitled herein as direct fascial glide with static unwinding (DFG-
SU), in a multitude of related variables: degree of disability and pain, shoulder girdle
kinematics and pectoralis minor length, unilateral upper-extremity strength, and
neurological functioning.
Methods: The intervention consisted of six treatments over a period of five weeks
with pre- and post-intervention examinations. Pain characteristics and degree of disability
was monitored with the Revised Short-Form McGill Pain Questionnaire (SF-MPQ-2) as
well as the Shoulder Pain and Disability Index (SPADI) and performance of Apley’s
scratch test, respectively. Shoulder girdle kinematics was examined via the combination
of an inclinometer and goniometer. Pectoralis minor length was assessed using a tape
measure against a table and a wall in supine and standing positions, respectively. A handheld
dynamometer allowed for the quantification of grip strength on the affected side.
Finally, tactile sensation and Tinel’s sign was compared using a three-point ranking
system from normal sensation to anaesthesia.
Results: Overall degree of pain, disability, and neurological pain ameliorated after
the intervention, yet no notable change in pectoralis minor length or shoulder girdle
kinematics was noted. Nonetheless, the restricted aspect of Apley’s scratch test and
unilateral grip strength improved by 3.5cm and 2kg, respectively. Finally, tactile
sensation and Tinel’s sign improved from presence of paraesthesia to normal sensation.
Conclusions: The results suggest that the MFR technique described herein
improved overall wellbeing and competence in daily tasks without significantly altering


The Effect of Massage Therapy on Postural Dysfunction Exacerbated by Parkinson’s Disease

Bronze Winner
Keiko Marumo
MacEwan University
Edmonton, Alberta, Canada

Background: The causes that lead to low back pain (LBP) vary, and include poor
postural alignment, muscle fatigue, and chronic conditions. Deviations from
balanced upright posture can result, leading to hypertonicity in compensatory
muscles. With increased kyphosis and forward head posture, affected tissues
include scapular retractors and anterior cervical muscles. With decreased lumbar
lordosis, affected tissues include lumbar, trunk and hip muscles. Conditions such
as Parkinson’s disease (PD), can exacerbate LBP, since a common sign of it is
postural change.
Objective: To show that massage therapy is effective in reducing LBP by
applying relaxation, myofascial release (MFR), mobilization, and stretching
techniques, and hydrotherapy heat to postural misalignment resulting from PD.
Methods: A 55-year-old male diagnosed with PD in 2012, presented with
shooting LBP in the left lumbar region after lifting a heavy gate. Clinical analysis
suggested muscle strain exacerbated by postural changes related to PD. The
treatment aim was to decrease LBP in the affected muscles. The treatment plan
involved 50-minute sessions of massage, once a week, for five weeks. Techniques
included hydrotherapy heat application, relaxation techniques, MFR techniques,
passive stretches, and passive mobilizations. The treatment was provided by a
second year massage therapy student.
Results: The patient reported an overall decrease in pain intensity, by rating pain
descriptors. The patient also reported a general decrease in disability caused by


Effect of Massage Therapy on the Proprioceptive System of an Autistic Child – A Case Study

Gold Winner
Rachel Benbow
HACC, Central Pennsylvania Community College
Harrisburg, PA

Background: Children with Autism Spectrum Disorder (ASD) often have an
underdeveloped or dysfunctional proprioceptive system, leading to significant
motor skill delays and increased anxiety. There is not enough clinical research to
prove the efficacy of massage therapy on proprioceptive dysfunction in children
with ASD, but if proven effective massage therapy could offer a new intervention
for this issue.
Purpose: The objective of this case report is to describe changes in the
proprioceptive abilities of a child with ASD after the application of 8 massage
therapy sessions over a four week period.
Participant: 5 year old female with mid to high functioning autism and
proprioceptive dysfunction. The client’s proprioceptive dysfunction impairs gross
motor planning and execution, creating gross motor developmental delays.
Intervention: Eight 40 minute massage therapy sessions, consisting of Swedish
massage and foot reflexology, were administered twice a week over four weeks.
Improvements in proprioceptive abilities were monitored through pre and postmassage
testing activities that included single foot balancing, jumping rope, backand-
forth ball bouncing, and independent ball dribbling.
Results: The client displayed improvement in proprioceptive testing tasks at a
much faster rate than her usual learning curve. Proprioceptive progress was
demonstrated by gains in gross motor skills pertaining to postural control, overall
body coordination, and use of force.
Conclusion: Although positive results were achieved within this case study, more
extensive studies are needed to verify the efficacy of massage therapy on
proprioceptive dysfunction in children with ASD.


Touching Pain: Massage Therapy Techniques To Support Adaptive Body Awareness for Self-Management of Chronic Pain Related to Spondylosthesis

Honorable Mention
Krina Patel
Cortiva Institute
Boston, MA

Background: Massage therapy techniques increase body awareness. Body awareness can be adaptive or maladaptive. Adaptive body awareness is shown to have a positive effect in the acceptance and management of chronic pain. Spondylolisthesis is a structural condition often accompanied with chronic pain.
Purpose: The present report investigates the efficacy of massage therapy techniques in enhancing and sustaining adaptive body awareness for the self-management of chronic pain related to Spondylolisthesis. Participant:  A 57-year-old female initially diagnosed with congenital spinal abnormality by a physician and subsequently with both congenital and degenerative Spondylolisthesis by a chiropractor presents with chronic low and upper back pain and frequent episodes of intense pain in these same areas usually brought on by physical activity. Client is familiar with general massage and acupuncture treatments.
Intervention: Therapeutic massage with the clear goal of increasing adaptive body awareness was introduced during a 4-week period. Five treatment sessions, each 45 minutes in duration used a treatment protocol that included diaphragmatic 4 breathing, various massage techniques in a ‘massage flow’ to relieve muscle tension and recommended home care. Verbal instructions encouraging patient to experience body awareness and sensations of muscles relaxing during massage were integral to the protocol.
Results: Client recorded a decrease in intense pain episodes between treatments, decrease in use of pain medication, no perceptible change in intensity of pain episodes and a better understanding of how to manage her chronic pain.
Conclusion: Patient feedback and therapist observation suggest that therapeutic massage with the clear goal of enhancing and sustaining adaptive body awareness through a treatment protocol carried out as a touch based dialogue between client and therapist may decrease pain-related anxiety and avoidance and increase capacity to accept and manage pain. This in turn may improve functioning and overall sense of wellness.


Massage Therapy Treatment and Outcomes for a Patient with Parkinson’s Disease

Gold Winner
Youlanda Casciaro
MacEwan University
Edmonton, AB, Canada


Background: Parkinson’s Disease (PD) is a complex neurological disorder. The root cause is unknown, and while treatment with pharmacotherapy is successful, eventually the effectiveness of the medications wears off. The disease is progressive and eventually results in severe disability. Symptoms are well-documented, with the most recognizable manifestations being resting tremor, bradykinesia, and rigidity.
Objective: To determine if massage therapy can produce favourable outcomes with respect to the severity of rigidity and tremor in a patient with PD. Methods A 63-year-old female patient with idiopathic, long-standing, Hoehn-Yahr Stage four PD was treated with massage therapy five times over the course of six weeks. A SPES/SCOPA Motor Impairments rating scale was used to measure rigidity and tremor pre- and post-treatment, to gauge treatment effectiveness. The massage treatments consisted of deep longitudinal stroking, muscle squeezing techniques, passive range of motion movements, and general relaxation techniques to encourage a soothing environment while promoting a decrease in muscular tone and hyperactivity.
Results: The results obtained indicated that massage therapy treatment had a positive effect on reducing resting and postural tremor in a patient with long-standing PD. The treatment was also effective to temporarily reduce rigidity during treatment, but did not produce a lasting effect.
Further study is required; however, the results of this case were consistent with the limited research available on the subject of massage therapy and Parkinson’s Disease, in that positive change with respect to resting tremor – and to a lesser degree, rigidity – were achieved with focused, intentional treatment.